EU should align with WHO air quality guidelines
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2023)

Air pollution is associated with adverse health effects including cardiovascular and respiratory disease, stroke, cancer, and dementia. Even low levels of air pollutants harm health and that is why WHO has recently tightened its limits in revised guidelines on air quality. Air pollution is the greatest environmental health risk in Europe, according to the European Environment Agency (EEA). Indeed, despite improvements in recent years, the mortality burden associated with air pollution remains high in Europe, with latest estimates from EEA of 238 000 premature deaths associated with particulate matter (PM2.5) and 49 000 premature deaths associated with nitrogen dioxide (NO2) in 2020. As part of the European Green Deal's zero pollution plan to have an environment free of harmful pollution by 2050, the European Commission published a proposal for a revision of the Ambient Air Quality Directives to align more closely with WHO's guidelines. Although the proposed revision is a step forward, it has been long overdue and is not ambitious enough, as the proposed limits would allow pollution levels higher than those recommended by WHO. Urban populations in particular are exposed to air pollution well above the health-based guideline level set by WHO. In this issue of The Lancet Public Health, Sasha Khomenko and colleagues provide novel insights into the health effects of sector-specific contributions to air pollution in European cities. Khomenko and colleagues assessed spatial and sectoral emission contributions to air pollutants and premature mortality in 857 European cities. The results indicated that for PM2.5-related mortality, the highest contributors were the residential and agricultural sectors, whereas or NO2-related mortality, the main contributor was transport. Large and capital cities contributed more to their own air pollution and mortality compared with small cities. This finding is important considering urbanisation is expected to increase by 83·7% by 2050. Taken together, Khomenko and colleagues’ findings show the scale of the issue and emphasise the need for coordinated actions across multiple sectors. To curb air pollution coming from traffic, several European cities have implemented low emission zones (LEZs), areas restricting access to vehicles that exceed specific exhaust emission standards. Rosemary Chamberlain and colleagues’ systematic review on the health effects of LEZs and congestion charging zones (areas that ban or charge most vehicles to reduce congestion) in cities found that LEZ schemes were consistently associated with a reduction in cardiovascular outcomes. London's ultra-low emission zone (ULEZ) provides further support that such schemes work if they are ambitious enough. London's ULEZ, first introduced in central London in April, 2019, is a stricter form of LEZ, charging vehicles not meeting specific standards. The scheme has reduced harmful pollution levels in central London by nearly half compared with what they would have been without the ULEZ and is due to be expanded in August. Between 2019 and 2022, the number of LEZs in Europe increased from 228 to 320 and is expected to grow to 507 LEZs by 2050. Apart from LEZs, zero-emission zones (ZEZs; areas that allow pedestrians, cyclists, and zero-emission vehicles only) could have even greater effects at reducing air pollution. A report by Clean Cities Campaign and Transport & Environment suggests that the introduction of ZEZs by 2030 might almost eliminate NO2 and bring WHO limits within reach even in Europe's most polluted cities. Despite the potential health benefits of LEZs and ZEZs, these were left out of the impact assessment that accompanied the proposal, missing the impact of policy actions that could help achieve ambitious targets. The progress to tackle air pollution in Europe remains insufficient, with schemes being implemented but still on a small and conservative scale. Truly aligning to WHO's air quality standards is feasible but will require stronger actions. The proposed revision of the EU Ambient Air Quality Directives falls short of setting ambitious targets to improve air quality in the region. Addressing air pollution not only improves health but also helps to mitigate climate change, therefore achieving important co-benefits. It is crucial that the upcoming European Air Quality Directives fully aligns with air quality guidelines set by WHO and puts health at the forefront. Europe has an opportunity to set an example and show global leadership in taking action to address air pollution. Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessmentWe estimated source-specific air pollution health effects at the city level. Our results show strong variability, emphasising the need for local policies and coordinated actions that consider city-level specificities in source contributions. Full-Text PDF Open AccessHealth effects of low emission and congestion charging zones: a systematic reviewLow emission zones (LEZs) and congestion charging zones (CCZs) have been implemented in several cities globally. We systematically reviewed the evidence on the effects of these air pollution and congestion reduction schemes on a range of physical health outcomes. We searched MEDLINE, Embase, Web of Science, IDEAS, Greenfile, and Transport Research International Documentation databases from database inception to Jan 4, 2023. We included studies that evaluated the effect of implementation of a LEZ or CCZ on air pollution-related health outcomes (cardiovascular and respiratory diseases, birth outcomes, dementia, lung cancer, diabetes, and all-cause) or road traffic injuries (RTIs) using longitudinal study designs and empirical health data. Full-Text PDF Open Access